Cost-Effectiveness of Screening for Hypertension and Counseling for Prevention

This article aimed to compare the health and economic impact of 3 services recommended by the US Preventive Services Task Force for the primary prevention of cardiovascular disease (CVD): (1) aspirin counseling for the primary prevention of CVD and colorectal cancer, (2) screening and treatment for lipid disorders (usually high cholesterol), and (3) screening and treatment for hypertension.

A microsimulation model was used to compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service. Primary outcomes of the model included lifetime quality-adjusted life years (QALYs) and cost-effectiveness, measured in incremental cost per QALY or cost savings per person in 2012 dollars. Results were also presented for population subgroups defined by sex and race/ethnicity.

The findings indicated that the health impact was highest for hypertension screening and treatment (15,600 QALYs) but was closely followed by cholesterol screening and treatment (14,300 QALYs). Aspirin counseling had a lower health impact (2,200 QALYs) but was found to be cost saving ($31 saved per person). Cost-effectiveness for cholesterol and hypertension screening and treatment was $33,800 per QALY and $48,500 per QALY, respectively. Findings favored hypertension over cholesterol screening and treatment for women, and opportunities to reduce disease burden across all services were greatest for the non-Hispanic black population.

Based on these findings the authors concluded that all 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient's demographic characteristics and clinical objectives into account.